Unexpected recovery of function after severe traumatic brain injury: the limits of early neuroimaging-based outcome prediction.
Unexpected recovery of function after severe traumatic brain injury: the limits of early neuroimaging-based outcome prediction.
复制标题
严重创伤性脑损伤后功能的意外恢复：基于早期神经成像的预测的局限性。
DOI：
10.1007/s12028-013-9870-x
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发表时间：
2013-12
影响因子：
3.5
通讯作者：
Hochberg, Leigh R.
中科院分区：
文献类型：
--
作者：
Edlow, Brian L.;Giacino, Joseph T.;Hirschberg, Ronald E.;Gerrard, Jason;Wu, Ona;Hochberg, Leigh R.
关键词：
创伤性昏迷早期的预后是神经重症监护病房的一个共同挑战。我们报告了一个19岁的严重创伤性脑损伤的男性意外恢复的功能里程碑（即意识，沟通和社区重新融入）。早期的核磁共振成像（MRI）结果，当时，提示预后不良。在患者康复的第一年，在第8天（昏迷）、第44天（最低意识状态）、第198天（创伤后混乱状态）和第366天（重返社区）进行MRI弥散张量成像（DTI）和T2*加权成像。采用残疾评定量表（DRS）对胼胝体、大脑半球白质和丘脑的平均表观扩散系数（ADC）和分数各向异性（FA）值进行比较。第8天观察到胼胝体和双半球白质中广泛的扩散限制，ADC值在典型的神经毒性损伤范围内（230至400 × 10 - 6 mm2/sec）。T2加权MRI显示大脑半球、胼胝体和脑干广泛存在出血性轴索损伤。尽管早期MRI显示存在严重的轴突损伤，但患者在损伤后一年内恢复了独立交流和日常生活活动的能力（DRS = 8）。在预测外伤性昏迷患者时，应谨慎解释MRI数据。即使早期MRI显示广泛的外伤性轴索损伤，意识恢复和社会重新融入也是可能的。
Prognostication in the early stage of traumatic coma is a common challenge in the neuro-intensive care unit. We report the unexpected recovery of functional milestones (i.e., consciousness, communication, and community reintegration) in a 19-year-old man who sustained a severe traumatic brain injury. The early magnetic resonance imaging (MRI) findings, at the time, suggested a poor prognosis. During the first year of the patient’s recovery, MRI with diffusion tensor imaging (DTI) and T2*-weighted imaging was performed on day 8 (coma), day 44 (minimally conscious state), day 198 (post-traumatic confusional state), and day 366 (community reintegration). Mean apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values in the corpus callosum, cerebral hemispheric white matter and thalamus were compared with clinical assessments using the Disability Rating Scale (DRS). Extensive diffusion restriction in the corpus callosum and bihemispheric white matter was observed on day 8, with ADC values in a range typically associated with neurotoxic injury (230 to 400 × 10−6 mm2/sec). T2*-weighted MRI revealed widespread hemorrhagic axonal injury in the cerebral hemispheres, corpus callosum, and brainstem. Despite the presence of severe axonal injury on early MRI, the patient regained the ability to communicate and perform activities of daily living independently at one year post-injury (DRS = 8). MRI data should be interpreted with caution when prognosticating for patients in traumatic coma. Recovery of consciousness and community reintegration are possible even when extensive traumatic axonal injury is demonstrated by early MRI.
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影响因子：
8.8
作者：
Galanaud, Damien;Perlbarg, Vincent;Puybasset, Louis
通讯作者：
Puybasset, Louis
影响因子：
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PITTS, LH
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48
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